The philosopher John Rawls suggested that the only ethical society is one which we design before we know what position we will hold in it. If you don’t know whether you’ll be born the child of janitor or a billionaire, black or white, you may view social justice differently than when you know that your [...]

Health care for a country as large as ours is going to cost a lot of money — no matter who’s paying the bills. Right now, the burden rests almost entirely on individuals to either pay extortion high insurance premiums & all the deductibles and copays required to actually benefit from those payments. But, many of us are hoping that with true government reform, those payments could be restructured in such a way that everyone in the country gains access to health care . . . and none of us go broke getting it.

Ezra’s hair is on fire but, why can’t he point out that we’ll pay much more than these estimates in ten years without reform?

Health reform is, I think it fair to say, in danger right now. The news out of the Senate Health, Education, Labor, and Pensions Committee was bad. The Congressional Budget Office had scored a partial bill and the result was a total fiasco. But the news out of the Finance Committee is much, much worse.

Put simply, the Finance Committee wanted its bill to cost $1 trillion over 10 years. The CBO returned an early estimate to the panel on Tuesday night: $1.6 trillion over 10 years. The specifics of the estimate have not been made public. But the final number changed everything. Max Baucus, the chairman of the committee, pushed markup back behind the July 4th recess. He has promised to get the bill below $1 trillion over 10 years.

That’s very dangerous.

“Very dangerous” — to say the least.

Bob Somerby at The Daily Howler has been attacking the cost issue with some interesting points.

The irony here should be obvious. We’re already spending twice as much as countries which already have universal coverage—and PW is willing to pay more to get what they already have! The oddness of this framework would occur to almost anyone in a different context. To wit:

You buy a car for $40,000. Your neighbor buys a car for half that amount—and his car is better! Someone then says your car can be almost as good as his—if you spend six thousand more.

Almost anyone would see the oddness of that situation. And yet, that’s the situation which obtains with our health care system. But so what! PW is eager to spend that six grand. In all likelihood, he doesn’t know the fact GB included—the fact that we’re already spending twice as much as the countries which have what we want.

Why doesn’t PW know that fact? Because of today’s New York Times! In the Times, Pear writes a perfectly accurate report about possible costs—but he doesn’t mention the remarkable fact which lies at the heart of our odd situation. Other countries already have what we seek—and they spend half as much as we do! You can read Pear’s report without learning that fact. In Pear’s report, we contemplate spending a trillion more—and still falling short of our goal.

We thought of poor Zeno as we read that report—Zeno, who proved, with his famous paradoxes, that you can never quite cross a room. You can get halfway, then halfway again—but you’ll never quite get all the way. New books still attempt to explain the way in which Zeno’s logic breaks down (click here). But don’t worry! If anyone ever figures that out, it won’t appear in the Times.

For the most part, American citizens didn’t chuckle when they read Pear’s report today. For decades, the basic frameworks of this debate have largely been kept from their view. How often do you read the fact which appeared in that letter from GB? As they perused Pear’s report today, how many Times readers thought to themselves: But we already spend twice as much!

Your current car cost 40 grand. But in France, they have better cars—for 20. For sixty years, your big news orgs haven’t told you that fact. We can’t tell you why that censorship exists. But we do emit low chuckles every time we encounter it.

For extra credit: First question: Have you ever seen a news report in the Times or the Post explaining why we spend twice as much as nations which have full coverage?

Second question: Could Zeno cross the room in that 40 grand car? As we all know: Yes, he could. Could he cross it better for 20?

Final question: What if he put an extra trillion into the car which cost 20 grand? How fast could he cross the room then? Within our thoroughly broken discussion, inquiring minds don’t want to know.

And today:

Why does the United States spend so much more for health care? Over the years, we think we’ve seen varying explanations, in the random tidbits of attention the question occasions. At one time, it seems that we would typically hear about the remarkable costs of paperwork, due to the blizzard of varying insurance forms created by our non-system system. In recent months, we seem to be hearing more about doctors performing unnecessary procedures. (As in one of these letters in last Wednesday’s New York Times.)
But we’ll ask you again: Have you ever seen a serious attempt in our major newspapers to tease out the answer to that question? A series of front-page reports in the Times, exploring various possible factors? Most issues are poorly discussed in the press, but we can’t think of another issue where the overall discussion has been so comically awful. Where the Big Major Basic Facts are so ruthlessly hidden. Where it’s so normal to see Major Pols spreading so much blatant disinformation—without little attempt by big news orgs to correct or challenge their statements. (We think of Rudy Giuliani, spewing spin in 2007 during the GOP primaries.)

Result? The debate now unfolding! Using those 2003 figures, we spend $5700 per person—while Finland spends only $2100. But in our current debate, we’re trying to figure how much more we’ll have to spend to get what Finland has!

Follow the link for some thrilling tables and talk about “rationing.” More on THAT later.

47 Responses

Health care for a country as large as ours is going to cost a lot of money — no matter who’s paying the bills. Right now, the burden rests almost entirely on individuals to either pay extortion high insurance premiums
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you know what, my father was a minister, and my mother was a great woman who lived with diabetes for many years, they paid into the insurance program for many moons with blue cross and blue shield, i remember them talking about the burden of payin it many times, but then, she got a brain tumor, and was
losing her swallowing abilities when she was 67, now
im not gonna take you throught the 2 and half months we shared with her at the hospital, but all i know is this.
They worked they paid, and when the 120,000 bill came
dad didnt have to pay anything, we were blessed that they had paid their premiums and that dad was not left with the burden.
You didnt pay, taxpayers didnt pay, and my dad had paid those premiums while sometimes complaining
paid his premiums. I can not imagine having an amount that the hospital had charged to have to have been paid by my father who was 74 at the time.
You can slaim insurance companies til you turn blue in the face, but when you are with a good company
it damn pays off sometimes.

That’s all true, carolflowery. But what you’re saying is “For $40,000, we did have a car.” That doesn’t change the fact that for $20,000 everybody could have an equally good car. (To stay with Somerby’s metaphor)

Carol, my son paid his premiums consistently and on time – when he needed brain surgery two years ago BC/BS baulked – it took a year of back and forth with and a good lawyer to finally get them to give him the coverage he needed – and in the meantime we watched him deteriorate – it’s taken him almost a year and he’s not quite back to where he should be yet.

I got your point but after going through a year of frustration and fear, I have a slightly different picture of American insurers

KB, I disagree. We spend way more per person for healthcare in the US than anywhere else. If we went toa government single payer plan it could cost us and business less than what it is costing now. They money needs to be redirected and used much more effectively. The idea that this will cost trillions is the big lie the insurance company lobbiests |(and the politicians they own) are scaring everyone with.
Medicare for all is the best option IMO. Right now businesses that provide healthcare could be paying a lot less in the way of taxes rather than heathcare plan contributions. With single payer doctors would have so much less paperwork they might even be able to run a whole office with one office person and a nurse or PA. With single payer malpractice would go down as everyone would have the same insurance and no need to sue a doctor or hospital to make sure your injuries are covered.
Right now John Conyers is the only person really organizing for this effort. I urge anyone interesed to go to his web page and se if there is something you can do to help.

I was responding to what I thought you were saying, that it was going to cost huge money to provide healthcare for everyone. |I may have misunderstood you as I see it costlng less or saving money to provide healtcare for everyone as long as we do it right.

The question for me is, “can the government run anything efficiently?” All I hear is that medicaid,medicare and ss are in danger. That always makes me skeptical. Right now I have $5000 deductible, and I am still wondering if the government can beat that without huge taxes on top of the expense we already encounter. Not a nay sayer, just a skeptic.

No, the govt is not great at running things absolutely efficiently. Nothing as huge and complicated as a national healthcare system lends itself to running like a well-oiled machine.

What people fail to realize is that in making that statement, they are making a baseless assumption that on the flipside, the bureaucracy, paperwork, administrative costs, etc (i.e. efficiency) is somehow BETTER with the insurance companies. That is an entirely illogical and faith-based assumption.

It isn’t more efficient. I ran my husbands medical office, and did his billing for years. Is Medicare a model of perfect efficiency? Nope. It’s a headache. But while Medicare (govt single-payer for all those over 65) may be a pain, the insurance companies are a HELL and a NIGHTMARE of conflicting rules, useless paperwork, and mindless bureaucracy, as well as a much more expensive (35% in administrative costs vs. Medicare’s 4%) process.

WHY do you believe that the current private insurance system is somehow more “efficient” and responsive and streamlined and cost-effective than a Medicare-like system for all would be? What facts support that conclusion? What’s the basis of that belief? Because every fact at my disposal over my years in the healthcare field tell me otherwise.

With the lost monies we have all the time , it turns my radar on anytime the government is involved. Don’t the doomsday scenarios of the above mentioned government organizations give you a moment of pause?

hey, |I was listening to Limbaugh today too. But I don’t fall for his sh*t. Government is not supposed to make a profit, it is supposed to serve the people.

You can mail a letter to anyone in the country for less than a dollar and get a package to them for 15 bucks. Do you have a problem with that?

Govenment in fact, in the form of medicare is a hell of a lot MORE efficient than private insurance companies and there are no executives who have to get part of your money for multimillion dollar pay days.

Yes, they do. I’m neither a utopian nor a Pollyanna. I do recognize that there are problems and drawbacks to single payer.

But where I take issue is the insistence of many that because A has some problems, B must be better. The facts don’t bear that out. A has some problems, B is a fucking nightmare. The insurance companies are not the solution to the problems of A, they are an even WORSE problem.

How is allowing a private, profit-driven industry to skim 35% off the top of every healthcare dollar in ANY way a solution to the minor drawbacks of A? It’s sheer insanity.

We need single-payer, because it’s the most efficient approach. How we do it, and what controls are put in place to avoid waste, fraud, etc are an issue that will need to be addressed. But rather than confront that, and work it out, the right wing points out the problems, then takes a huge leap into fairytale-land by asserting that a system with even MORE waste, fraud, and mindless bureaucracy is the solution.

Would you like for your police dept to be run the same way as healthcare? How about your Fire Dept?

I am not pro-big govt. I have no desire to live in a socialist country, because I believe it stifles innovation, and growth. I believe strongly in economic individualism, and the engine of innovation that a free market and competition provides.

Where I part ways with that is where LIFE and limb is concerned – those services that people have no choice over, that they cannot predict their need for, that they cannot choose to buy or not buy, and therefore cannot participate in a truly free-market manner in order to keep competition high and costs low.

Police protection and fire protection are 2 of those type services. Govt takes care of them, not with perfect efficiency, but with relative efficiency. If police and fire protection were left to the private sector, insurance, and “competition”, can you imagine the hell that would result? Are you going to argue about coverage, and whether the firetruck in front of your house is “in network” for your plan, while your house burns??

Healthcare falls into that category. When people are sick, they have no choice, they MUST get care. When a consumer is “over a barrel” in that manner, free market forces are non-existent. This is the reason why price-gouging is outlawed after natural disasters: because market forces to control costs DO NOT WORK when the consumer has no choice, no options.

I am a strong advocate of free markets and competition. But I do not worship them blindly – I recognize where they are effective, and where they are hamstrung by realities that make them null.

Look at it this way. In the current system you are paying retail for healthcare. You are not buying directly from the provider (wholesale), you are supporting a massive, profit-driven industry that only exists to be the middle-man getting a massive mark-up. The insurance companies pull in billions and billions of healthcare dollars, for doing nothing other than allowing all those healthcare dollars to pass through their hands.

How is that “more efficient”? How is having lots of hands in the pot between the point of origin and the point of purchase a cost-saver?

I am currently looking at installing hardwood floors. We are finding the best prices at Lumber Liquidators. Why? Because the retailers at the fancy showrooms have 2 or three middlemen taking their profit off the top before that flooring ever gets to me.

It’s a simple economic concept. Fewer fingers in the pie = more and cheaper pie for the consumer. If the govt program is the only finger in the pie, the only middleman, then yeah, there is a cost. But the govt (as demonstrated with Medicare) is not making a PROFIT. They are covering their administrative costs, and that’s about it.

The cost per patient to cover Medicare is FAR lower than the cost per patient to cover the insured, because the middleman is not taking a HUGE skim off the top.

It’s actually pretty simple, but gets obscured via all the heated rhetoric. In what world is a middleman taking 35% CHEAPER than a middleman taking 4%????

Exactly! Insurance companies are in business to make “money”, a profit. With a not for profit form of health care there would be far less paper work. You would still have the same doctors, nurses, hospitals. You just wouldn’t have to go through the middle man, an accountant/lawyer type, to decide what “medical” tests are appropriate to run for you condition! I find it interesting that so many doctors are for single payer.http://www.pnhp.org/facts/single_payer_resources.php
I have good health insurance but I strongly believe that everyone has the right to the pursuit of happiness. That is difficult to do if you are not healthy or not able to seek medical care because you’re worrying about paying bills. My sister died an early death because of the lack of health insurance. She didn’t seek medical attention until she had no choice. She didn’t want to burden her family. In the end, she didn’t get the care she should have because of money. I know my sister is not alone. I will gladly give up my health insurance if all can be covered by single payer! Why should anyone get better care just because they can afford it? Is Bill Gates life really more valuable than yours or mine? If you cannot see the value in what I say, than just think about all of the people you come in contact with on any given day. Do you really want that person that’s coughing over your groceries to not be covered? Do you really want people coming in from other countries illegally bringing in possible diseases, sitting next to you on the bus, to not be able to go get vaccinated? I think the health of our country is directly tied to the health of its people. I don’t care how much money you make or where your descendants come from, health care should be available for all and no one should have to worry about losing their homes or what it will cost them!

the reason they are in trouble is that they are automatic adverse selection organizations. No insurnace company would take only old sick and poor people on as customers. They need the healthy rich and and young to make a profit. When we are all in including the young and healthy, single payer will work much better than Medicare and medicaid do. Right now they are underfunded. Imagine taking even 70 percent of the money that is being paid to private insurers and making that the base from which single payer operates…no longer underfunded it would be the best healthcare in the world.

Here’s another one of my concerns: if we have universal health care, what happens to situations in which you get bad care? So, today for negliegence assuming you have the $ you can sue the industry in court (ok, I know good luck winning), but with a government agency, it’s much much more difficult. Just ask anyone who had to go through the VA Board of Appeals process. It’s just another reason we need to have a real debate about this.

I think most people believe that we are going to get as good care as senators do, but I just don’t see how that is feasible. Again, our country needs a real debate about this. I had hoped with Hillary winning POTUS, we’d have a debate and solutions would be discussed. But with Obama, it’s like he’s gonna ram whatever he believes will work down our throats.

People do not sue insurance companies, generally – they sue the doctor. It is next to impossible to sue an insurance company or HMO for lack of coverage.

What happens now if a person 65 or older gets bad care? They change doctors, they sue their old doc, etc. Same thing under UHC. No one is advocating the govt taking over ownership of hospitals, or docs becoming paid govt employees. Single payer govt insurance would function like Medicare, and there have not been problems with bad care/lack of recourse with Medicare.

The New Yorker has an excellent article written by a doctor who did a study on the effectiveness and outcomes of health care in McCallum, Tx and El Paso, Tx. The interesting thing about this is that the two communities are very parallel in their general make-up but McCallum spends a fortune more on health care than El Paso. Yet, the health outcomes in El Paso are actually better. What the Dr. points out in his study is that what happened in McCallum (which used to be about the same as El Paso in health care expenditures) is that adding treatments and tests became a way to gin up hospital revenues; doctors became involved in cooperatives that did MRIs and other tests.

I know there are huge variations in these tales but it puts the focus on what is important here—the essentials are not about insurance or who puts up the $$$, single payer or whatever—the essentials are access to effective, high quality health care for all. And high quality health care must place a premium on wellness, early detection, preventive strategies etc.

I listened to Obiewan’s speech the other day on HC before the AMA. I think I have earned my creds here as not an Obie person so I will say that he did say some things in that speech that I think are part of the essentials—and he talked about the issues of quality/effective care and universal access. He also said some things I do not buy into but his effort is not totally off the mark.

About bipartisanship—-I think it is necessary. I think they should have established a bigpartisan commission to work on this. We need to move toward consensus—not capitualation. The Dems want to crown themselves with credit; the Repubs want to hang them on a cross of worthless greenbacks. Bi-partisan commissions do work.

Actually, government can run things reasonably efficiently. Social Security has been going some 70 years. Medicare has been going for 40. Millions have received benefits over those years. To anybody who thinks private business would have done it better, I ask: Ever tried to contact your health care provider? Or the phone or cable company?

Government programs get screwed up when 1) the people put in charge of them are massively corrupt, or 2) the people in charge sabotage them to prove political points. We’ve seen both happen over the last eight years under the Republicans. Unfortunately, it doesn’t look like it’s getting better under the Democrats.

But then, Big Business hasn’t exactly gotten kinder or gentler – or more efficient – over those years, either. It’s because the same greedy blowhards are the powers behind both.

We need consensus? No. We need enough votes to enact something. If we can get them all from Dems, fine. There’s no political parties in the Constitution, much less a requirement that politicians from both are required to pass anything.

Let me describe modern Dems’ idea of consensus. Someone steals his wallet. He objects. The thief says, hey, there’s 200 bucks here. Let’s compromise. I’ll take $100 and you take $100. The Dem agrees and goes home all warm and tingly because he reached consensus, not caring that he just got played for $100.

Buy the DVD: http://www.shoppbs.org/entry.point?en… BMJL4306_052209:N:DGR:N:N:609:QPBS Washington’s abuzz about health care, but why isn’t a single-payer plan an option on the table? Public Citizen’s Dr. Sidney Wolfe and Physicians for a National Health Program’s Dr. David Himmelstein on the political and logistical feasibility of health care reform.

Obama said he needed the Senate, and congress in control by the Democrats to have Single Payer and POTUS (being a Democrat too). So, what is his excuse? He has no excuse, and he is keeping the Single Payer Advocates out of the Health Care Reform discussions.

I meant it literally. You seem to be taking the position that a govt plan would be an example of waste and inefficiency, whereas private insurance would be less so.

I’ve laid out pretty clearly my very logical reasons, backed up by real observations and data, why that is not so. You’ve failed to do the same for your point of view. If you’d like to give me some actual concrete reasons why private insurance works better as a whole than a single-payer plan, please do so.

Actually, my questions are based from an economic position. We are pulling the purse strings in so many direction that I question the governments ability to sustain these expenses. Based on my first statement that showed my personal $5000 deductibe, i thought it would be a given that a better system would be personally favorable. I am not against the idea if it can be financially agreeable for everyone.

Most of the data I’ve seen says it would be less expensive per person than the current system. After all, you are lopping 35% of every dollar right off the top that goes to sheer profit/administrative cost for the insurance companies.

Middlemen indeed have become a terribly serious problem in health and medical care. Obviously, the average person needs “affordable,” insurance (although that term also has become meaningless), but something has gone seriously wrong in recent decades.

I have been involved in health care policy and issues since the 1960s — before and after Medicare/Medicaid. I’ve heard all of the arguments, complaints, and misgivings about access, quality, cost containment, overutilization of insurance, and third-party payer hassles on medical diagnoses, treatment, and payment. I’ve heard many physicians complain as much about private insurance company hassles as about government programs — and in recent years more about private insurers as Medicare became much more efficient. (True, that took a lot of oversight and complaint from physicians before it came about).

I have also experienced very poor response from a private provider that had once been a state government program — ie, no help whatsoever for a mentally ill brother with a brain tumor. In effect, there, was nowhere to turn. But I know this: simply placing a program in the hands of private insurance carriers does not insure health care access or even adequate care. There was a time when Blue Cross-Blue Shield did a pretty good job of not making decisions for physicians and not denying payment for care (although that depended on which state/region was running the program.)

Sadly, I also know there are physicians that refuse to take new patients under Medicare or Medicaid programs — often leaving persons with that type of insurance out of the medical care loop. (I understand the reasons, but people nevertheless are left out even when they can pay something.) Before Medicare/Medicaid, many, but not all, doctors treated such persons as “charity.” I don’t believe people want charity; however, they do need medical care at times despite their best intentions to just stay healthy.

In summary, I don’t know what the answer is — I only know that neither patients nor providers (a silly term) are being served very well now. Our system of third-party payers (which can be different each time a person changes to a different “provider”), is costing far too much and leaving far too many people out of the health care loop. Of course, I know physicians who believe that we should never have passed Medicare/Medicaid — but there were some gaps in care even before third-party payers took over, so I don’t totally agree with that. On the other hand, what we have today is mind-boggling. Nevertheless, I cannot help but feel that what Congress is doing now is going to make things much worse for everyone but the major money-makers — generally the big insurers.

alwaysthinking — you offer some interesting perspective here. One thing that has been a benefit for WI govt workers is the merging of prescription coverage across all health insurance plans. This way we are able to switch plans and switch all prescriptions with ease; you also are assured that you know which prescrips are covered and how much because they are all consolidated into tiers. The only problem I’ve seen with it is if a particular prescript is hard to get under one plan, say Celebrex, than you can’t switch plans to get it covered.

But this is due to more streamlined coverage, and not because there is some central electronic file on us.

The current prescription drug plan, in my opinion, is a mess. But I am speaking personally rather than from any thorough analysis. People obviously need the option to get the specific brand/generic meds that their doctors suggest. Sometimes a specific drug works for an individual; sometimes it doesn’t. The option to switch plans would be one possibility, but then, there may be other aspects of the plan that are negative, so one still could be caught between the devil and the deep blue sea.

Another point we haven’t addressed is the necessity of huge electronic medical records on each and every person. To me, if we just have single-payer health care akin to Medicare, there is no need for such records because the doctors/hospitals would be simply paid an agreed upon amount per procedure or visit. But a complete overhaul of whatever Obama is alluding to supposedly requires having mass records on everyone in order to save costs? I just don’t get this. Is this the case in other countries … where they would have a central database with all citizens medical information? I don’t see the need for it, and the potential ramifications are frightening. Incidentally, many ins companies are already making all their records easily accessed to each unit, with sending in prescriptions and lab results being sent right away to doctors.

I still feel we have more questions than we do answers, and I just want a real public debate. Even if the republicans don’t really offer anything, isn’t this where the Devil in the details get flushed out?

I’m for national health (single payer), have been fighting for it for 20 years. But some of these statements are getting carried away. We don’t pay twice as much as european countries — it’s more like 110 to 150% in comparable economies. And administrative costs average no where NEAR 35% — industry standard pays our 80% in claims. They may reach 30-35% in badly run companies but that’s not an average (for those unaware, it’s 80-85% claims, 17-25% administrative…guess where the difference comes from and have fun calculating the stability of your company…)

Bad, but not the same figures I’m seeing quoted here (I currently work in an industry whose survival depends on tracking these numbers). I’m from the UK originally and my aunt died of pneumonia while bedridden waiting for a hip operation that my mother signed on for here in no time — twice.

Health care *will* be rationed in ways we aren’t used to, and healthy, childless people like myself *will* pay more. I accept that extra cost, for the general good and for my own peace of mind and security. Mostly I support it for the general stability of our economy. But let’s not stick our heads in the sand about what it’s going to cost or who’s going to pay. We have a lot more unhealthy, and low wage earners than most of Europe — and national health isn’t going to change that. We’ll get less than they do in Europe for, for many of us, more than we pay now. In the UK most of my relatives have private insurance on top of their national health.

So certainly let’s go forth and lobby for this change, but personally, store a few bucks away because your still going to need them.

I’m for national health (single payer), have been fighting for it for 20 years. But some of these statements are getting carried away. We don’t pay twice as much as european countries — it’s more like 110 to 150% in comparable economies. And administrative costs average no where NEAR 35% — industry standard pays our 80% in claims. They may reach 30-35% in badly run companies but that’s not an average (for those unaware, it’s 80-85% claims, 17-25% administrative…guess where the difference comes from and have fun calculating the stability of your company…)

Bad, but not the same figures I’m seeing quoted here (I currently work in an industry whose survival depends on tracking these numbers). I’m from the UK originally and my aunt died of pneumonia while bedridden waiting for a hip operation that my mother signed on for here in no time — twice.

Health care *will* be rationed in ways we aren’t used to, and healthy, childless people like myself *will* pay more. I accept that extra cost, for the general good and for my own peace of mind and security. Mostly I support it for the general stability of our economy. But let’s not stick our heads in the sand about what it’s going to cost or who’s going to pay. We have a lot more unhealthy, and low wage earners than most of Europe — and national health isn’t going to change that. We’ll get less than they do in Europe for, for many of us, more than we pay now. In the UK most of my relatives have private insurance on top of their national health.

So certainly let’s go forth and lobby for this change, but personally, store a few bucks away because your still going to need them.
Sorry, forgot to add great post! Can’t wait to see your next post!

We’re finally finding out what “affordable” means to a Senator. It means that you spend 15% of your income for insurance premiums that cover 65% of your expenses. (and no one knows if that includes co-pays and deductables)

And that 15% of your income will go to private insurers (just like it does now)

a) I don’t know where you got those numbers but they don’t appear to be adjusted for what people actually receive in each country (we have far more cases of type II diabetes, for instance, and a much heavier use of diagnostic testing) — all of which cost. Further, to compare you have to specify whether you include unproven expenditures such as the large amount spent by Belgians on homeopathy and US citizens (and their insurance companies) on chiropractors and other relatively useless procedures that we are culturally bound to pay — and in large sums.

b) 100% coverage in the UK? I’ve used their system and think it’s good, but I just told you my aunt died for treatment she would have got here so don’t give me 100% anything…no one has 100%. People in the UK are pulling their own teeth, and traveling abroad for care. 100% is NOT true.

c) What I said was “Health care *will* be rationed in ways we aren’t used to”. Of course it’s already rationed, but the rationing will be very different and people should be prepared for this.

And that’s all I’m giving is a warning — shit happens you aren’t expecting and I see a lot of people thinking this will be utopia which it won’t. I think it’s the best option; what we have sucks. But I’ve seen people rely on the national health alone with bad results…this is only a person warning to be prepared. Look into BUPA and ask why they are so successful in the UK, and then keep your policy current.

You know what, now probably *is* the time for ideological delusion. That’s how stuff gets done. Those of you who get what I’m saying, keep your policies active — you’d probably already planned to. But otherwise we’ll just have to let people suck this one up.

Struggling with Links, Blockquotes, images or videos?

By Lambert Strether of Corrente. Readers, I’m sorry I missed Water Cooler Monday. Perhaps it would be simplest to say I was trapped in a chrono-synclastic infundibulum. TPP Lori Wallach on the leaked investment chapter [Eyes on Trade (PDF)]. The tribunals would be empowered to order payment of unlimited government funds to foreign investors over […] […]

Body: This paper, or pre-draft, or sketch, or whatever it is, started out with this title: "With The 12-Point Platform, this won't happen: An aristocracy of credentialism in the 20%." But then I realized I'd gotten in deeper than I thought -- one of those posts were the framework and the notes overwhelm the original idea -- and as it tur […]